MRS. CHRISTAN BENNETT BROOKS (NPI# 1114266731) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114266731 |
| Entity Type | Individual |
| Full Name | MRS. CHRISTAN BENNETT BROOKS |
| Other Name | MS. CHRISTAN LATONYA BENNETT |
| Credential | MSW, LCSW |
| Practice Address |
12058 San Jose Blvd Ste 104 Jacksonville FL 32223-8669 |
| Mailing Address |
5137 Admiral Dr Jacksonville FL 32244-3163 |
| Practice Telephone | 9043256616 |
| Mailing Telephone | 9046319771 |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2020-10-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 104100000X | Social Worker | 160994624 | FL | Behavioral Health & Social Service Providers |
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
SW13712 | FL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 029573621 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1010 Executive Center Dr, Suite 100, Orlando, FL 328033529 | 3212813840 | |
| 43 Knight Boxx Rd Ste 1, Orange Park, FL 32065 | 9045793960 | |
| 5610 Fort Caroline Rd, Jacksonville, FL 32277 | 9043379788 |
| Street Address |
12058 SAN JOSE BLVD STE 104 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32223-8669 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730182940 | Lynda R. Mance | Social Worker | 12058 San Jose Blvd, Suite 703, Jacksonville, FL 32223-8666 | 2005-05-23 |
| 1992298921 | Christina R Lee | Social Worker | 12058 San Jose Blvd, Jacksonville, FL 32223-8666 | 2018-06-13 |
| 1649502006 | Millie Dean Russell | Dentist | 12058 San Jose Blvd, #102, Jacksonville, FL 32223-8666 | 2010-02-09 |
| 1164651220 | Nancy Ann Busch | Social Worker | 12058 San Jose Blvd, Ste 703, Jacksonville, FL 32223-8666 | 2009-07-10 |
| 1922288364 | Krantz Dental Care, P.a. | Dentist | 12058 San Jose Blvd, Suite 102, Jacksonville, FL 32223-8666 | 2007-11-13 |
| 1811187271 | Mandarin Counseling Inc | Social Worker | 12058 San Jose Blvd, Ste 703, Jacksonville, FL 32223-8666 | 2007-07-31 |
| 1780736983 | Jacqueline Boudreau Viola | Social Worker | 12058 San Jose Blvd, Suite 703, Jacksonville, FL 32223-8666 | 2007-01-17 |
| 1356455000 | Luis E. Quinones, Md, Pa | Psychiatry & Neurology | 12058 San Jose Blvd, Suite 903, Jacksonville, FL 32223-1842 | 2006-08-19 |
| 1871509810 | Rosalind Ann Heller-slevin | Nurse Practitioner | 12058 San Jose Blvd, Suite1003, Jacksonville, FL 32223-8666 | 2006-07-31 |
| 1851338818 | Luis E. Quinones | Psychiatry & Neurology | 12058 San Jose Blvd, Suite 903, Jacksonville, FL 32223-1842 | 2006-05-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679103600 | Karen Gabriela Alexander | Dietitian, Registered | Ackerman Cancer Center, 10881 San Jose Blvd, Jacksonville, FL 32223 | 2020-01-17 |
| 1891250049 | Thalia L Honea | Occupational Therapist | 12766 San Jose Blvd, Suite 716 & 717, Jacksonville, FL 32223 | 2019-02-01 |
| 1447758289 | Stephanie Ann Murphy | Marriage & Family Therapist | 11543 Halethorpe Drive, Jacksonville, FL 32223 | 2018-01-26 |
| 1861948481 | Nicole Gay | Developmental Therapist | 12276 San Jose Blvd, Ste 5, Jacksonville, FL 32223 | 2016-09-01 |
| 1740694439 | Robyn K Mizelle | Behavioral Analyst | 12276 San Jose Blvd. Great Strides Rehabilitation, Suite 507, Jacksonville, FL 32223 | 2014-06-20 |
| 1184038010 | Kelli Anne Cabrera | Occupational Therapist | 12350 San Jose Blvd, Jacksonville, FL 32223 | 2014-06-18 |
| 1891031910 | Mandarin Family Medicine, P.a. | Preferred Provider Organization | 12276-210 San Jose Blvd, Jacksonville, FL 32223 | 2012-12-18 |
| 1114201811 | Darshana Choksi | Pharmacist | 3663 Marbon Rd, Jacksonville, FL 32223 | 2011-09-30 |
| 1346539988 | Harris Wilcox and Donovan Pa | Optometrist | 11790 San Jose Bl, Jacksonville, FL 32223 | 2011-04-05 |
| 1740517796 | Beth A. Kelley | Occupational Therapist | 2640 Scott Mill Dr, Jacksonville, FL 32223 | 2009-11-12 |
| Find all providers in zip 32223 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748193 | Sophia Venditti | Social Worker | 2598 Post St # 1, Jacksonville, FL 32204-4256 | 2020-10-22 |
| 1629676093 | My Journey, LLC | Social Worker | 13453 N Main St Ste 204, Jacksonville, FL 32218-2773 | 2020-10-16 |
| 1104423524 | Sonya Young | Social Worker | 920 Bridier St, Jacksonville, FL 32206-5904 | 2020-10-08 |
| 1043823115 | Sierra Lashonda Murray | Social Worker | 9246 Thunderbolt Dr, Jacksonville, FL 32221-8052 | 2020-08-28 |
| 1235741901 | Deidra Lewis | Social Worker | 4480 Deerwood Lake Pkwy Unit 134, Jacksonville, FL 32216-2255 | 2020-08-23 |
| 1497365456 | Darlene Denise Rolle- Cargill | Social Worker | 14050 Integra Dr Apt 420, Jacksonville, FL 32218-2592 | 2020-08-05 |
| 1689282626 | Andrea Kristin Perkinson | Social Worker | 128 Plow Point Ln, Jacksonville, NC 28546-9591 | 2020-07-15 |
| 1255956371 | Noel Roman | Social Worker | 11775 Carson Lake Dr W, Jacksonville, FL 32221-3812 | 2020-06-15 |
| 1285257535 | Phaith Coaching & Counseling, LLC | Social Worker | 4940 Emerson St, Jacksonville, FL 32207-4963 | 2020-05-21 |
| 1407478613 | Mara's Lighthouse Counseling Center, LLC | Social Worker | 6015 Morrow St E Ste 114, Jacksonville, FL 32217-2125 | 2020-05-11 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32223 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.